The No Force First journey… DR JENNIFER KILCOYNE IRIS BENSON MBE

Aims No Force First Service User Involvement Impact and Outcomes Next Steps

What is Perfect Care? Mersey Care is striving to provide perfect care for the people we serve. At its core, this means we are an organisation that does not accept compromises in the quality of care or minimum targets set by others, but supports continuous learning and improvement in our services so that we strive to get the basics of care right ever time, for every service user. This is a bold ambition in difficult times, but with engaged and motivated staff and supportive commissioner and partner organisations, we firmly believe it is possible. Perfect Care means: Setting our own stretching goals for improvements in care rather than aiming to meet minimum standards set by other organisations Getting the basics of care right every time Making improvements to the care we provide because we know it's the right thing to do for patients and because we care about the care that we provide. Helping people to try improvements, learn from their mistakes, and apply what works more rapidly. Helping our people to innovate in ways that create better quality and outcomes for the people we serve whilst reducing cost. 'Striving for Perfect Care' understanding the strategic wheel Our vision is underpinned by four aims and 14 objectives. These aims and objectives are set out in our strategy wheel and describe our strategic direction and how we wish to be viewed both within and outside the Trust. Our plan for the coming year is based around four aims and underpinning objectives that set out what we will achieve: Our services - we will improve the quality of our services, and strive to provide safe, timely, effective, equitable and person-centred care every time, for every service user. This means getting the basics of care right consistently, repeatedly and predictably. Our people - we will have a productive and high performing workforce that work in great teams, and we will work side by side with service users and carers. Our resources - we will make full use of our resources, continuously finding ways to save time and money, ensuring our buildings work for us, and using technology to help improve our care. Our future - we will create opportunities for improvement and grow in the future, by working more closely with primary care and other organisations, delivering the benefits of research, development and innovation, and by growing our services. Perfect Care priorities The three initial areas of focus for Perfect Care are reducing restraint in inpatient areas improving the depression pathway. improving the physical health of those in our care However there are also other programmes that are connected to Perfect Care, such as Lockton analysis, The Health Foundation project, Improving Quality (IQ) project, Innovate Dementia

No Force First Staff Engagement Events: Co-produced and Delivered Quality Improvement Methodology (PDSA) Cycles of Evidence Based Interventions Results of PDSA Cycles Across Teams Mersey care NHS Trust have chosen NFF as our Restrictive Practice Reduction Strategy which commenced in April 2012 The initiative was developed to fundamentally change how challenging behaviour was dealt with in mental health units in the US due to an increase in restraint related deaths. -It aims to change in-patient culture from one of containment to one of recovery. -Sets force elimination as the ultimate goal. -De-briefing patients and staff whenever force is used. -Characterize relationships with patients as ‘risk sharing’ partnerships rather than ‘risk management’ control. -Use of peer support, involving people who use services with co-production and co-delivery -Effective use of advance statements/crisis management plans. -with Compassion Care at its core which demonstrates a Trauma informed perspective on challenging behaviour, recognising the negative life experiences that can generate it. So, Leads were identified from the trust to drive the NFF Initiative With the aim to strive to reduce incidents of restraint to zero So far we have: -Linked this to safeguarding & to Implementing Recovery through Organisational Change Programme, (ImROC) -Recruited champions from every service to plan and implement -Identified Dr Dave Fernley as Executive Sponsor and we receive support from (AQuA) The Advancing Quality Alliance is a NHS health and (care quality improvement) organisation. -We set up governance via a Steering Group and Operational Group and to date we have piloted 5 wards within the Secure Division – (Keats, Johnson, Blake, Tennyson, Popular) - Ward inductions to NFF were facilitated through Staff engagement events which consisted of standard briefing and awareness sessions co-produced and delivered by experts by experience -We use Quality Improvement Methodology to measure improvement such as (e.g. driver diagrams and PDSA cycles) plan, do, study act -Cycles include core evidence base interventions and those identified by the staff team as a priority for their service area -The results of PDSA cycles are then fed back to the Operational and Steering Groups Initial Outcomes were positive across the pilot wards- There was evidence of: -Reduced incidents of physical and medication led restraint -Reduced incidents of violence and aggression -Improved staff sickness levels -Increased patient & staff satisfaction To maintain the positive outcomes we have : -Gained bottom up and top down support: Board and staff ownership: -We have Connected NFF to the strategic vision, aims and objectives -Promotion of achievements (We have been short listed for the Health Service Journal Patient safety awards this year) -We plan to roll out the evidence based PDSA cycles across the trust (PLAN, DO STUDY ,ACT) -And ensure key areas are targeted and progress is evaluated

Key Areas Restraint Seclusion and LTS Supportive Observation Rapid Tranquilisation

Key Elements Listening and Collaboration Flexibility Compassion and Trauma Informed Care Positive Recovery Focused Communication DVD and Guide www.youtube.com/watch?v=PJP-oCPf_CA So, this slide illustrates the key elements of the No Force First approach. The First is to show a commitment to listening to service users and using ‘Advanced Statements’ and peer support workers to demonstrate the value of lived experience in improving care. To show flexibility as further described in Positive & Proactive ensuring we move away from a rule based culture of unhelpful rules and procedures which are there for the organisations benefit and not the service users recovery. To show compassion and understanding so that behaviour is always seen in the context of past events to ensure we deliver trauma informed care. And engage in positive, recovery focused, communication as how we talk about service users strongly influences how we treat them. For example one of the significant PDSA’s used by wards has been around positive handovers to ensure that staff approach each new shift with a optimistic mindset.

Impact

Impact 2

Service User Involvement Co-production and Delivery Your Voice Your Change Events Values Based Recruitment Service User Training

Quality and Governance Implementation Through Quality Account Highlighted as a Trust Strategic Priority Supported by Aston Team Coaching Review of Policies and Practice

Impact and Outcomes Positive CQC Review Winner at Patient Safety Awards Lockton’s Analysis of NFF Practice Standards Data Driven Improvement Service User Experience The pilot phase is now completed and analysis of the pilot data has indicated that this is a positive strategy for both patient and staff both in terms of their quality of experience and effective use of resources. ( Stockton Analysis Insurance Company). We are now currently inducting new staff into the approach and we are reviewing this induction is carried out. We aim to have all HDU Wards inducted by July 2015 And all wards in the secure division by December 2015 We are also looking at the infrastructure of the data collection to support this roll out. We are also looking at developing a set of key standards so that the NFF can be audited in the future and becomes integrated into the culture of the wards. We have discussed and the received support from the patients via the patients forum and Your Voice Your Change Events and we are looking at developing key roles for patients currently using our service

Next Steps No Force First Organisation Increasing Service User Involvement Improvement and Sustainability Further Research Partnerships

Any Questions? jennifer.kilcoyne@merseycare.nhs.uk